Two misconceptions regarding bladder health issues are that it is the inevitable part of the aging process OR that it only affects women after irreversible damage from childbirth. Well, that isn’t true. Both populations are at a higher risk, but that’s not where the story ends: 25 million Americans suffer from bladder control problems, with 75% of them being women and 25% men. While women are more likely to suffer from stress urinary incontinence due to childbirth and menopause, men are more likely to experience urinary urgency, retention, hesitancy, and flow problems as the result of an enlarged prostate. Male or female, bladder control problems are usually symptomatic of an underlying cause, and can be helped no matter the severity or chronicity.
The Urinary System
The male and female urinary system consists of the kidneys, ureters, bladder, and urethra. The kidneys make the urine and pass it into the bladder (via the ureter), which in turn is responsible for storing and elimination.
The function of the bladder
About the size of a pear, the bladder is located just behind the pubic bone and held in place by the pelvic floor muscles (PFMs) and ligaments that surround it. When the bladder is not full of urine, it is relaxed. When it stretches and fills with urine, the brain tells the bladder to relax, and you get the urge to urinate . The detrusor muscle (which surrounds the bladder) then contracts, and urine is pushed out from the body through a tube called the urethra. The urethra has muscles called sphincters, which help keep the urethra closed so urine doesn’t leak before you’re ready to go to the bathroom. These sphincters open up when the bladder contracts.
The role of the pelvic floor muscles for bladder support
One of the functions of the pelvic floor muscles (i.e. the muscles that support the bottom of the pelvis) is bladder control. The layers of muscles stretch like a hammock, from the tailbone in the back, to the pubic bone in front, supporting the organs that lie within it..When the PFMs contract, the internal organs lift up and the urethral sphincters tighten to allow the bladder to be filled with urine. When the muscles relax, it allows the passage of urine. So either weakness or tightness of the pelvic floor muscles can limit the function of the bladder and result in bladder problems.
Common causes of urinary problems in men and women
- Pregnancy and childbirth: For women, injury during pregnancy and childbirth can affect how effectively the nerves, ligaments and PFM support the bladder. Carrying multiples, type of delivery and the number of children a woman has, can all increase the risk of urinary incontinence. Also, with increased weakness of the PFMs, the bladder can also sag into the vaginal opening (cystocele) and cause the opening of the urethra to stretch.
- Menopause: In this period the production of estrogen in the body reduces which causes atrophy of the vagina and the urinary tract. This weakens the entire urinary system and comprises the integrity of the bladder. Reduced estrogen also changes the acidity of the vulva and vagina, making it more prone to urinary tract infections and yeast overgrowth.
- Benign prostate hyperplasia (Enlarged prostate): The prostate is part of the male reproductive system, and is located just below the bladder and in front of the rectum. The urethra runs through the center of the prostate. So growth of the prostate, which occurs during most of a man’s life (particularly after the age of 25) can disrupt the function of the urethra.
- Trauma Or Surgery: Pelvic fractures and surgical procedures to the pelvis and groin like prostate surgery, radiation therapy and hysterectomies can all lead to nerve damage to the bladder, and affect its function.
The most common bladder conditions for men and women
- Urinary Incontinence (UI): UI refers to accidental leakage of urine and the 3 most common types are:
- Stress Urinary Incontinence (SUI): This is the involuntary loss of urine with coughing, sneezing, and heavy lifting, and more common in women,
- Urge incontinence or Overactive Bladder Syndrome: This refers to the uncontrollable loss of urine after an overwhelming urge to urinate.
- Overflow Incontinence: This occurs when the body makes more urine than the bladder can hold, or it stays full and has a hard time completely emptying. This causes urine to leak or a dribble after voiding. This is most common with men.
- Mixed incontinence: This is a mixture of stress and urge incontinence and is most common with the senior population.
2. Interstitial Cystitis (IC) or Painful Bladder Syndrome: This is a chronic and painful condition that is typically characterized by bladder pain (particularly when the bladder is full), pelvic or abdominal pain, pain during sex, and/ or a frequent urge to urinate. The exact cause of IC is not known, although people with IC tend to have a defect in the protective lining of the bladder that leaks toxic substances in the urine and irritates the bladder wall. While it’s more common for women to have IC, men can also get it and will usually experience pain in the penis, testicles or scrotum.
3. Bladder Prolapse (Cystocele): This occurs when the ligaments and muscles that support the bladder weaken and stretches and allows the bladder to bulge down into the the vagina. Straining the muscles (i.e during vaginal childbirth, with chronic constipation, during violent coughing or with heavy lifting) can all cause this.
4. Urinary Tract Infections (UTIs): UTIs are more common in women than men and it mostly have to do with the fact that the female urethra is only about 2 inches long (shorter than men), so the bacteria has a shorter distance to travel to get from the vagina. Symptoms associated with UTIs are burning during urination, incontinence, coupled and even low back pain.
10 Simple Physical Therapy (PT) Tips for a healthy bladder
Tip #1: Watch what you drink/ eat
Certain foods and drinks like citrus fruits and coffee can irritate the lining of the bladder and urinary tract. It can exacerbate bladder issues like IC, and urge incontinence. So consider the
following: Instead of:
– Alcohol..Water
– Coffee.. Drink Herbal Tea
– Seltzer.. Drink Spring Water
– Dark Chocolate.. Eat Carob
– Raw Onions.. Eat Cooked Onions
– Citrus Fruits.. Eat Blueberries/Pears
Tip #2: Hydrate, hydrate, hydrate!
Water helps to flush out microbes in the kidneys, bladder and urinary tract, reducing the chance of infections in these areas. A common misconception is that by reducing water intake you reduce the chances of having accidental urine leakage, however, doing this is counterproductive. Avoiding water causes the bladder capacity to reduce. As it reduces, stored urine gets more concentrated and irritates the lining of the bladder. This in turn makes the bladder more sensitive and prone to further infections. Aim to drink at least 8-10 glasses of water daily.
Tip #3: Keep a bladder diary
An easy way to start to ‘re-train’ the bladder, is by keeping a log to help you track some details about your voiding habits. For 24 hours, record:
– Your input: How much fluid you consume.
– Your output: The number of times that you urinate.
– The number and amount of accidents that occur: For example if you leak a small,
moderate or large amount of urine.
– When these incidents occur: For example, when laughing,
coughing, exercising.
Tip #4: Don’t hover over the toilet
The problem with hovering over the toilet to pee is the impact it has on the bladder. In this position, the pelvic floor, abdominal, hip and thigh muscles all have to tense up. This position makes it hard for the bladder to completely relax for urine to flow easily. Ultimately, it contributes to problems like pelvic organ prolapse (from bearing down to pee), urgency, frequency, and increased risk of infections (from incomplete bladder emptying).
Tip #5: Pee after NOT before sex!
Some physicians greatly caution against urinating preemptively before sex as it can do the complete opposite in increasing the risk of an infection. This is because the bacteria that gets pushed into the urethra from the vagina during sex needs a solid stream to sufficiently push it out when you urinate. If you don’t have a strong enough stream (because you’ve urinated beforehand), the trapped bacteria can cause an infection.
Tip #6: Strong AND flexible PFMs is key!
If you have experienced bladder problems at any point, you have most likely done OR been told to do kegels. As appropriate as these exercises are on occasion, they are often done incorrectly OR the issue may not actually be pelvic floor muscle (PFM) weakness. In cases like IC, the PFMs may be tight and overactive, so trying to strengthen them can only make the pain worse. So be sure that you are doing the most appropriate pelvic floor exercises.
Tip #7: Mind over bladder!
A normal interval between bathroom visits is 3-4 hours. So if you find that you are going more frequently (after recording it in your bladder diary), start a practice of techniques like deep breathing, visualization, and diversion techniques to suppress the urge before the next scheduled visit.
Tip #8: Consider hormone therapies
For both men and women, addressing age-related hormone imbalances can significantly help the overall health of the urinary system. For men, treatment with estrogen and testosterone can address UI symptoms, while for menopausal women, vaginal estrogen could be beneficial.
Tip #9: Manage your stress levels
Stress doesn’t cause bladder problems like IC, but it can exacerbate the symptoms. So consider stress management techniques like a daily meditative practice to reduce the risk of flare ups.
Tip #10: Get a Pelvic PT consult!
We are specifically trained in evaluating, treating and establishing effective self care strategies for most bladder issues. So reach out and trust that you are not alone!
Ann Udofia, PT, DPT
Ann is a Doctor of Physical Therapy, the co-founder of Body Connect Health & Wellness in Washington D.C, and manual therapy based pelvic health PT (women and men)
References:
- http://www.urologyhealth.org/Images/Media/Male-Incontinence-Infographic.jpg
- http://www.urologyhealth.org/urologic-conditions/neurogenic-bladder/the-urinary-system
- http://www.webmd.com/urinary-incontinence-oab/picture-of-the-prostate
- https://urogyn.coloradowomenshealth.com/patients/library/menopause-urinary-symptoms/
- http://my.clevelandclinic.org/health/diseases_conditions/hic_Am_I_Pregnant/hic_Coping_with_the_Physical_Changes_and_Discomforts_of_Pregnancy/hic-pregnancy-childbirth-bladder-control
- http://www.womensinternational.com/connections/bladder.html